Electronic records have automated the process of documenting care and made patient information available on-line and in real time. They have also enabled redesign of provider work flows and the use of patient information in ways never possible with paper. There are those who might argue that certain of these changes have and continue to be problematic, but the profound and lasting impact (for example) of automated order entry, real-time clinical decision support, medication administration and on-line documentation cannot be denied. The pursuit of electronic records has been transformational, amounting to the automation of the core business much like that of other industries to which healthcare is often compared. However, the higher value of electronic records is now ready for harvest. With this first phase of transformation largely complete, it’s time to move into the volume-value shift through the real-time and retrospective use of the data and all things mobile.
The Art of Adaptation
Providers are now required to devote more time to documentation, data entry and other electronic record functions. EMR/EHR and related technologies are now at the very core of healthcare delivery. As such, a major shift in thinking and in workflow is occurring, driving the need for cultural and process change across the care continuum. Organizations must achieve full adoption and compliance with the demands of automation, otherwise inefficiencies will increase, frustration will mount and patient care/safety will be at risk. If a decision is made to pursue a particular level of automation, all must be on board. Inconsistent use of technology at the point of care can be very dangerous.
"The pursuit of electronic records has been transformational, amounting to the automation of the core business"
Unfortunately, interoperability still means “interfacing” in the context of disparate systems and their ability to exchange information. Organizations continue to address this as in the past–with a set of detailed specifications certified and supported by the vendors in play. Although this may for some time remain the approach to interoperability among competing vendor technologies, the industry must get to a point where full consensus is obtained on the specific format and content of exchanged data and that interoperable “data exchange adapters” are built into vendor products as native code. Vendor products should ultimately contain a number of standard/ common data elements (in both format and meaning)which work as an integrated application feature and seamlessly hook to the “data exchange adapters” common with what resides in other products.
Thrusting Technological Trends
I believe the architecture of what many might presently refer to as “an integrated product” offers the example of true interoperability. It has to be native to the technology product– meaning it’s just “there.” Being able to replicate that on a bigger scale that binds disparate vendor products is my idea of where things could ultimately need to go. The use of APIs is of course becoming more popular and will likely produce progress, but I would personally like to see things interoperable “out of the box” without the need for a third party technology. Maybe APIs are the initial glue to begin binding all of this together, but I prefer a native, built-in data exchange capability.
A Resolute Defense Against Expenses
Those providers who can’t afford to invest in the technologies and people to stay in the game will likely consolidate with another provider(s) or somehow partner with some entity that can bring the expertise and technology. However, there are many smaller organizations (including physician practices) that have been very successful in their HIT endeavors. An organization’s local market may have something to do with this as a highly competitive healthcare delivery marketplace is going to exert HIT investment pressures on all providers that other markets less competitive may not. But the reality is that many components of information technology “cost what they cost”, regardless of an organization’s size, net revenue or industry. In the future, I believe those smaller organizations who struggle with funding IT will likely have market share, volume and/or margin problems that force a significant change in their business model.
Emphasis on Innovation
While CIOs are working to ensure their organizations have the requisite technologies to support population health management, bundled payments, clinical integration and other aspects of the “volume to value” shift, they are also pressured to contain costs, effectively support and maintain their embedded base of technology and manage what in most organizations is an ever increasing demand for solutions and services. Additionally, the recruitment and retention of skilled and experienced staff continues to grow in challenge and strategic importance. Truth be known with regard to vendor technologies, most organizations (personal opinion) struggle to make good and effective use of what they have. I contend there is ample technology available to transform healthcare, even though the frustrations of inadequate interoperability remain. The problem in many organizations is adoption and variation in use.
Remember that change is constant and technology continues to evolve. But what is important, always, is that investments bring the value that justified their purchase. Solution providers will continue to enhance and grow their products, or eventually go out of business. Staying up-to-date is vital both on a personal level as well as throughout an organization’s technology portfolio. Organizations must allocate funding to continuously maintain their embedded based of systems and technologies. EMR/EHR technologies will be here for many years to come, and they will continue to change and improve. All things mobile will become more integrated into care, especially as the industry pursues consumer (i.e. convenience) strategies and more efficient and cost effective ways to keep populations healthy and out of the hospital.
Courtney Fisher-Lewis, Associate CIO, Saint Luke’s Health System & Ex-Sr. Director, IS Program Management, Children’s Mercy Hospital David Chou, SVP & CIO, Harris Health System & Ex-Chief Information & Digital Officer, Children’s Mercy Hospital